[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-452828-105":59,"doc-detail-452828-en":131},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":124,"head_meta":126,"extra_data":128,"updated_unix":130},105,"en","a-rare-case-of-apparent-mineralocorticoid-excess-induced-by-chronic-liquorice-ingestion","A rare case of apparent mineralocorticoid excess induced by chronic liquorice ingestion","","Apparent mineralocorticoid excess (AME) is a rare syndrome caused by inhibition of renal 11β-hydroxysteroid dehydrogenase type 2 (11β-HSD2), most commonly from chronic liquorice ingestion. The report describes a 61-year-old woman with profound hypokalaemia, metabolic alkalosis, and QT prolongation from heavy liquorice tea consumption. The case highlights the need for detailed dietary and over-the-counter medication history in unexplained electrolyte abnormalities and demonstrates potentially fatal cardiovascular effects.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/a-rare-case-of-apparent-mineralocorticoid-excess-induced-by-chronic-liquorice-ingestion/452828/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/a-rare-case-of-apparent-mineralocorticoid-excess-induced-by-chronic-liquorice-ingestion/452828.png","ImageObject",300,407,{"name":92,"@type":93},"MrHarris58","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-31","2026-09-30",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",14,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"What causes apparent mineralocorticoid excess in this case?","Question",{"text":113,"@type":114},"The case attributes AME to chronic liquorice ingestion, which inhibits renal 11β-HSD2 and leads to mineralocorticoid receptor activation.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"What symptoms and lab abnormalities did the patient develop?",{"text":118,"@type":114},"The patient developed persistent, resistant hypokalaemia with metabolic alkalosis and QT prolongation, along with ECG findings including frequent premature ventricular complexes.",{"name":120,"@type":111,"acceptedAnswer":121},"Why is dietary and OTC history important in patients with electrolyte disorders?",{"text":122,"@type":114},"A thorough dietary and over-the-counter medication history can identify liquorice as the exposure; failure to recognize it can lead to unnecessary investigations and potentially life-threatening complications.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},452828,1790825213,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":19,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":52,"preview_page_count":4},687212988360,"https://ap-avatar.wpscdn.com/davatar_276721f389ce27ea32af1340a28f341c","EDM Case Reports (2026) 2026 EDM250120  \n[https://doi.org/10.1530/EDM-25-0120](https://doi.org/10.1530/EDM-25-0120)  \nReceived 24 August 2025  \nAccepted 15 December 2025 Version of Record published 5 January 2026  \nA rare case of apparent mineralocorticoid excess induced by chronic liquorice ingestion  \nAparajita Roy􀀁1 and Kieran Mullins2  \n1Department of Cardiology, King George Hospital, Barking, Havering and Redbridge University Hospitals NHS Trust, Ilford, UK  \n2Department of Acute Medicine, King George Hospital, Barking, Havering and Redbridge University Hospitals NHS Trust, Ilford, UK  \nCorrespondence should be addressed to A Roy: [aparajita.roy1@nhs.net](aparajita.roy1@nhs.net)  \nSummary  \nApparent mineralocorticoid excess (AME) syndrome is a rare condition caused by the inhibition of the renal enzyme 11β-hydroxysteroid dehydrogenase type 2 (11β-HSD2) . The most common acquired cause is chronic liquorice ingestion. We report the case of a 61-year-old woman who developed profound hypokalaemia, metabolic alkalosis, and QT prolongation due to excessive liquorice tea consumption. This case underscores the importance of detailed dietary history in patients with unexplained electrolyte disturbances and demonstrates the potentially fatal cardiovascular consequences of a widely available herbal remedy.  \nLearning points  \n• Hypokalaemia may present subtly but can carry life-threatening risks.  \n• Apparent mineralocorticoid excess should be considered in patients with resistant hypokalaemia and unexplained hypertension.  \n• A thorough dietary and over-the-counter medication history is essential in the evaluation of electrolyte disorders.  \n• Liquorice, although natural, can exert potent physiological effects with severe clinical consequences.  \nKeywords: liquorice; apparent mineralocorticoid excess; hypokalaemia; mineralocorticoid receptor  \nBackground  \nLiquorice, derived from Glycyrrhiza glabra, has been used for centuries in traditional medicine and remains popular today in herbal teas and over-the-counter preparations for gastrointestinal symptoms (1) . Its principal active compound, glycyrrhizin, is metabolised to glycyrrhetinic acid, which inhibits 11β-hydroxysteroid dehydrogenase type 2 (11β-HSD2) in the distal nephron. This enzyme normally converts cortisol to its inactive metabolite cortisone, preventing inappropriate activation of the mineralocorticoid receptor. Inhibition of 11β-HSD2 leads to cortisol-mediated mineralocorticoid receptor activation, resulting in sodium retention, potassium wasting, hypertension, and metabolic  \nPublished by Bioscientifica Ltd.  \n[https://edm.bioscienti](https://edm.bioscienti)fi[ca.com](ca.com)  \n© 2026 the author(s)  \nalkalosis – collectively known as apparent mineralocorticoid excess (AME) (2) .  \nRecent narrative reviews have emphasised that liquorice toxicity remains under-recognised, despite welldocumented reports of severe hypertension, rhabdomyolysis, arrhythmias, and sudden cardiac death associated with excessive glycyrrhizin ingestion (3) . Failure to identify the culprit exposure may lead to unnecessary investigations, including adrenal imaging, genetic testing, or invasive procedures. While regulatory assessments regard 100 mg of glycyrrhizin per day as safe, cases of liquorice-induced hypertension and  \nThis work is licensed under a Creative Commons Attribution-NonCommercialNoDerivatives 4 .0 International License.  \nA Roy & K Mullins EDM Case Reports (2026) 2026 EDM250120  \n[https://doi.org/10.1530/EDM-25-0120](https://doi.org/10.1530/EDM-25-0120)  \nelectrolyte disturbance have been reported at much lower doses, highlighting marked inter-individual variability in glycyrrhetinic acid sensitivity (3) . If unrecognised, liquorice-induced AME can precipitate life-threatening electrolyte abnormalities and malignant arrhythmias.  \nCase presentation  \nA 61-year-old Caucasian woman was referred for persistent hypokalaemia over the previous 4 months that was unresponsive to oral potas","cbCaifggRgbpSNjZ","https://ap.wps.com/l/cbCaifggRgbpSNjZ","pdf",162899,"English","# Summary\n## Learning points\n# Background\n## Case presentation\n## Investigation\n## Treatment","[{\"question\":\"What causes apparent mineralocorticoid excess in this case?\",\"answer\":\"The case attributes AME to chronic liquorice ingestion, which inhibits renal 11β-HSD2 and leads to mineralocorticoid receptor activation.\"},{\"question\":\"What symptoms and lab abnormalities did the patient develop?\",\"answer\":\"The patient developed persistent, resistant hypokalaemia with metabolic alkalosis and QT prolongation, along with ECG findings including frequent premature ventricular complexes.\"},{\"question\":\"Why is dietary and OTC history important in patients with electrolyte disorders?\",\"answer\":\"A thorough dietary and over-the-counter medication history can identify liquorice as the exposure; failure to recognize it can lead to unnecessary investigations and potentially life-threatening complications.\"}]","A rare case of apparent mineralocorticoid excess induced by chronic liquorice ingestion | PDF",1790737751]